Dysphoria Matters: On the Broken Promise of “Sex Education”

DESPITE BEING acclaimed for getting its T4T (trans for trans) sex scene right, Sex Education, Netflix’s teen dramedy series, gets gender dysphoria—a term that has become synonymous with trans experience—all wrong. In her Transgender History (2008), trans theoretician and filmmaker Susan Stryker explains gender dysphoria as a sense of unhappiness over the incongruence between how one subjectively understands one’s gender and how one’s gender is perceived by others. This definition, widely accepted by both the trans and medical communities, takes the emphasis off the person experiencing such feelings. Instead, it suggests that dysphoria is unhealthy, transient. It is the mismatch between private feeling and public reception, rather than the trans person, that needs fixing.

While definitions of dysphoria have changed in medical, psychiatric, social, and T4T contexts over the past five decades, Sex Education leaves all this complexity behind by sacrificing the Black nonbinary trans character at the altar of ignorance and presenting a gloomy, one-dimensional, and potentially dangerous trope of dysphoria: an all-encompassing, all-consuming, permanent state of unhappiness.

After debuting in 2019, Sex Education dropped its fourth and final season this September. During the show’s run, it received critical acclaim for its treatment of sexuality and intimacy, performance, writing, directing, and production value (winning a BAFTA TV Award for Best Female Comedy Performance and an International Emmy for Best Comedy Series).

Stylistically, the colorful tones, the bright California lighting (in a show set in Wales), drone shots, and vintage costume design send strong 1980s US vibes, a la The Breakfast Club (1985), which the show references in its second season. Several interviews with the show creators have delved into this aspect with limited answers. The choice seems to be generational and is shared by the creators of fellow Netflix series Stranger Things (2016– ).  These stylistic choices, which so many current showrunners grew up on, coupled with an optimistic DEI council atmosphere, were meant to provide some nostalgic comfort during the Trump era.

Sex Education, which has spent three seasons delving into diverse sexual desires, practices, and orientations on a typical high school campus (your regular shark tank), takes a distinct turn in its final season. It unfolds within the confines of what some may label a “woke” college led by a dynamic trio of trans, queer, and crip students of color: Abbi, a white transfeminine student (Anthony Lexa); her Black, Deaf, queer, and polyamorous confidante Aisha (Alexandra James); and her transmasculine POC boyfriend Roman (Felix Mufti).

While certain liberal critics have hailed the setting of Cavendish College as “utopic,” “gender euphoric” in fact paints a more fitting description. What’s truly euphoric is the casting of talented trans, nonbinary, Deaf, and disabled actors of color for these roles.

The finale’s explicit purpose is to celebrate trans joy and disability justice, working from the premise held throughout the show that everyone gets a chance to heal from trauma. This may happen through the mere recognition of the mental mechanism at play and, more seldom, through a lengthier therapeutic process. The show’s promise has been that if you honestly open up about what you’re dealing with, face the issue, and get support, you will work through it and thrive. Otis (Asa Butterfield), the protagonist, resolves erectile dysfunction issues by talking about them; Lily (Tanya Reynolds) had vaginismus figured out by opening up about it with a partner and using dilators; and Eric (Ncuti Gatwa) successfully works through Black and gay identity issues by traveling to Nigeria, to name a few.

This is realized in the finale when each of the new and old characters gets to find peace: the cis teen who was sexually assaulted on the bus, the cis teen who was bullied at camp, the asexual teen, even the transfeminine teen who has been shunned by her family and faith community.

Regrettably, Cal (Dua Saleh), the Black trans nonbinary student grappling with gender dysphoria and suicidal thoughts, emerges as the most underdeveloped character, eventually abandoned in the narrative’s denouement. This framework simply fails to apply to Cal. Despite vocalizing that “I don’t think the world really wants people like me in it” and acknowledging their dysphoria, Cal remains trapped in the same mental anguish. Unlike all the other adolescent growing pains that can be therapized, Cal’s gender dysphoria is so severe that it confines them to bed.

Everyone heals but Cal.

Why does Abbi, who has faced familial rejection, faith community ostracism, and housing instability, appear to be “cured” of dysphoria, while Cal, whose mother is (eventually) accepting, battles suicidal ideation linked to their dysphoria, triggered by an intimate scene with Aisha, in which they discover they’re on their period? How is it that Cal attends a college where they consult with a fellow transmasculine student of color about top surgery but still cannot find a sense of community? Cal also has a heartwarming conversation with a Black gay friend (Eric) who supports them and tells them that “[t]hings have to change […] because people like us aren’t going anywhere.” Despite knowing that fellow students are willing to contribute to their top surgery fund, Cal continues to struggle with what seems like, but is not named as, severe depression.

Trans scholarship, film, and literature, by and about trans people, are exploring the nuanced experiences of dysphoria, while neoliberal representations tend to be one-dimensional, reactionary, and preachy, the latter being what the show has been accused of. In Side Affects: On Being Trans and Feeling Bad (2022), trans and intersex studies scholar Hil Malatino focuses on the “bad feelings” that “inform and transform trans arts of living.” Dysphoria, according to Malatino, diagnoses the negative affect of an individual in reference to their experience of mismatch, and this is the reason that popular narratives about transitioning describe it as shifting from dysphoria to euphoria. He offers to demedicalize these narratives by detaching them from the dysphoria/euphoria paradigm and using different language.

Until the very end, Sex Education avoided this perhaps too optimistic transition trope, the issue Malatino takes with such representations being that they exclude “the durability of negativity, the bad feelings that persist before, during, and after such moments of euphoria […] the bad feelings that transition doesn’t, can’t possibly, eliminate.” Malatino offers insightful and resonant language to describe the phenomenology of trans dysphoria/bad feelings beyond the limitations of “transition.”

In the show, the shift from dysphoria to euphoria is evaded but replaced with the conflation of severe depression and dysphoria, thus luxuriating in Black trans trauma. Cal’s treatment in the final season is marred by a medical perspective that pathologizes the trans experience, treating dysphoria as an all-encompassing individual affliction while neglecting to address the systemic oppression of cissexism, anti-Black ableism, and healthcare disparities. With private top surgery beyond their family’s financial reach, Cal faces a bleak future. Dysphoria is wielded as a catchall diagnosis to explain any tribulation a trans person endures, but the show fails to delve into whether Cal’s condition might improve or worsen should they receive care—emotional support or medication—for depression. This oversight is particularly glaring in a series centered on therapy.

As “the story goes”—screenwriter, author, and cultural critic Hari Ziyad writes for the Black Youth Project—Black people are “historically resistant to treating their mental health”:

The more generous tellers of this story will grudgingly admit that this resistance stems at least in part from anti-Blackness within the mental health industry, and the larger Eurocentric medical model in general. We have been burned by Tuskegee experiments and Drapetomania diagnoses, and so we avoid the fire, even when we might need its heat as the world around us freezes over.

Ziyad explains the deeper reason they themself avoided therapy when they needed it in the past:

We don’t need cures for every trauma and disability. We need a world that doesn’t make living with our traumas and our disabilities unbearable (although, of course, medications can and should help make living manageable).

They conclude by proposing that perhaps Black people are resistant to mental health treatment because that problem has always been social, not personal. “What healing might it offer all of us to always look at our pathologies—both real and projected—with understanding and care?”

While Cal’s ending is unusual to the show, it is quite the standard trope in disability-related melodramas focusing on the physical difference of apparent disabilities (the terms “apparent,” “non-apparent,” and “intermittently apparent” were suggested by disability studies scholar Margaret Price to move away from vision-centered, stable categories) to arouse the spectator’s sentimental emotions. Such films’ narratives expose various aspects of injustice and social exclusion, while still concluding with the protagonists’ deaths: for example, Whose Life Is It Anyway? (John Badham, 1981), Mask (Peter Bogdanovich, 1985), and Million Dollar Baby (Clint Eastwood, 2004). By each film’s end, the viewer is left with a paternalistic sense of pity towards people with disabilities, moved to tears but not to action. The ableist gaze in these melodramas coincides with the medical one and relieves the viewers from any possible imagination of (social) change.

In Million Dollar Baby, for example, rising star boxer Maggie (Hilary Swank) is paralyzed in a particularly brutal match. Maggie, like Cal, has many reasons to be depressed—the loss of her dream to win the championship, neglect at the rehabilitation center, and the amputation of her leg as a result, not to mention family alienation. Million Dollar Baby concludes with Maggie’s only supporter, her coach, Frankie (Clint Eastwood), offering to help her through euthanasia, which she accepts. Doris Zames Fleischer and Frieda Zames have argued that, superficially, this film seems to support marginalized social groups, whether a blind Black boxer or a 31-year-old working-class female boxer, but in actuality, it relies on the assumption that euthanasia is an act of kindness towards people with disabilities. In Cal’s case, had they not been “diagnosed” with “fatal” gender dysphoria after a single sex scene, the show wouldn’t have left them in bed wanting to die but would’ve followed the premise and offered them care for their depression.

By contrast, Netflix’s longest-running original animated series, Big Mouth (the first three episodes of season four, from 2020, have titles like “The New Me,” “The Hugest Period Ever,” and “Poop Madness”) manifests gender dysphoria as a pasty anxiety mosquito character named Tito (voiced by Maria Bamford). Trans character Natalie (voiced by Josie Totah) is only visited by Tito three times, initially in the boys’ bunk at camp, where Tito flies around her, blurring space and pausing time, buzzing at her: “Oh, God, coming here was a terrible mistake. Look at them. They hate you. The camp clearly did not read that detailed email from your mother. Say something already!”

Tito gradually disappears as Natalie advocates for herself, introduces her new name and pronouns, and answers the boys’ intrusive questions. When they ask about her genitals, the mosquito reappears buzzing around her, “Oh, God. This is a disaster, but don’t cry. They’ll think you’re weak, and they’ll pounce.” Later, in the girls’ bunk, she gets a visit from Tito as the girls are excitedly offering to femme her up (or rather butch down). Dysphoria Tito makes her dissociates, buzzing around her, “Just agree with them now and then think about this for the rest of your life.” The remainder of Natalie’s narrative is not at all euphoric; it focuses on pre-blockers struggles with her hormone monster, while Tito moves on to other campmates. At the same time, Natalie has other non-dysphoria-related mental and social problems, like many of her cis peers, as well as some that are unique to her trans experience.

Natalie’s nuanced character on Big Mouth is a direct result of Totah’s involvement in developing the character she voiced. Cal’s character also had a gender consultant, Shay Patten-Walker, a Black trans and nonbinary activist who contributed to the development of the character as well as to their gender euphoric counterparts, Abbi and Roman. But while Sex Education and its creators have been hailed for the timely and necessary involvement of an intimacy coordinator, Ita O’Brien, their gender advisor was only mentioned briefly, with a slide on the season’s fifth episode paying tribute to Walker after their tragic death by suicide at age 24 in February 2022.

Like Cal, Shay grappled with depression. Their Instagram post from Trans Day of Visibility in 2021 provides context:

Feeling or being seen for me is so important. I feel seen when people see the whole me. When people respect me. In all my Transness, Blackness and Queer[ness]. I feel seen when people don’t assume my pronouns. I feel seen when people call me my correct name. I feel seen when I see other BLACK TRANS AND NON-BINARY GREATNESS. I feel seen when I see trans people THRIVING. […]

I don’t have a problem being trans, I have a problem with the way [I and] other trans people are treated because we are trans. Some Barriers including safely transitioning, employment, legal recognition & Trans healthcare.

Can live-action television catch up with Black Disability Politics, a historic and contemporary perspective offered by disability studies scholar Sami Schalk? In her interview with poet and activist T. S. Banks in Black Disability Politics, he argues:

[I]f we can make accessibility [mean] thinking about access to food, health, housing, heart, art, you know, everything that makes us thrive instead of just surviving, you know, human beings, I think if we can do that for Black disabled, trans folks, nonbinary folks, intersex folks, I think, you know, basically the world has won.

Or perhaps with trans-crip studies’ nuance, or, at least, animation? These are questions worth exploring.

Endings aren’t everything, but they do matter. In a show often described as an unrealistic haven of gender euphoria, Cal deserves an ending that acknowledges both their Black trans and nonbinary identity and their struggles with depression. By attempting to bring a dose of dark realism to the utopic vision of Sex Education, the series replicated familiar and deeply conservative melodramatic conventions around race and disability.

A more uplifting imagined future for these characters—one that sparked a movement within the school, bringing trans, crip, and Mad communities together to combat ableism, racism, and transphobia—would have done the show a deeper, truer justice. Picture students rallying for Isaac (George Robinson), Aisha, and Cal’s access to healthcare, housing, and education, working collaboratively against institutionalization and incarceration, as our communities have done in real life (see Liat Ben-Moshe’s continuous work and latest book, 2020’s Decarcerating Disability: Deinstitutionalization and Prison Abolition, in particular).

As the history of gender dysphoria shows, trans people seeking to alleviate negative feelings were central to shaping both the diagnosis and trans discourses of dysphoria/euphoria. Moreover, through depathologizing medicalized gender dysphoria, we can uncover trans and gender nonconforming coping mechanisms and survival strategies, and find new solidarities with crip and Mad communities, from whom trans folks have been historically segregated. Had trans and disabled communities and movements not been politically divided since the trans exclusion from ADA protections (only now being rectified), perhaps Cal would have had a more fulfilling conclusion. We might have also remembered that many pioneering trans activists, like Reed Erickson, Marsha P. Johnson, and others were also crip and Mad. There’s more to trans folks’ mental health than dysphoria.

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Slava Greenberg is an assistant professor of film in the Department of Media Studies at University of Amsterdam's Faculty of Humanities and Amsterdam School for Cultural Analysis.